Tricuspid valve operations in 530 patients. Twenty-five-year assessment of early and late phase events.
From Jan. 1, 1961, through Dec. 31, 1987, 530 patients underwent an intracardiac operation that included a tricuspid valve procedure. The tricuspid valve was repaired in 351 patients (66%) and replaced in 179 (34%). Mean age was 56.9 years. Risk factors associated with tricuspid valve replacement included tricuspid stenosis (p = 0.02), jugular venous distention (p = 0.04), previous operation (p = 0.05), and angiographic severity of tricuspid valve incompetence (p less than 0.001). There were 78 hospital deaths (15%). Risk factors for hospital death included previous operation (p = 0.03), male gender (p = 0.03), hepatomegaly (p = 0.03), De Vega or Carpentier annuloplasty (repair group only), (p = 0.01), and older age at operation (p = 0.06). Ninety-eight percent of the patients were followed up. There were 185 late deaths (41%). The actuarial survival rate was 20% at 180 months. Risk factors for late death included male gender (p = 0.03), hepatomegaly (p = 0.04), and lack of postoperative warfarin therapy (p less than 0.001). Actuarial freedom from reoperation was 25.5% at 180 months. There was no difference in reoperation rates (p = 0.10) or survival (p = 0.42) whether the tricuspid valve had been repaired or replaced. We conclude that the requirement for surgical treatment of tricuspid valve insufficiency in patients with multivalvular disease constitutes a high risk group for cardiac surgery. Preoperative variables may predict the result of tricuspid valve replacement. Tricuspid valve replacement may be performed with the expectation of a low risk of valve-related events.
McGrath
L B
LB
Department of Surgery, Deborah Heart and Lung Center, Browns Mills, NJ 08015.
Gonzalez-Lavin
L
L
Bailey
B M
BM
Grunkemeier
G L
GL
Fernandez
J
J
Laub
G W
GW
D000368:Aged; D001807:Blood Vessel Prosthesis / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011475:Prosthesis Failure; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013927:Thrombosis / Q000209:etiology; D013997:Time Factors; D014261:Tricuspid Valve / Q000601:surgery*